Atlanta Sports Podiatry
Organization Active NPI Podiatrist · Johns Creek, GA
NPI 1902371073 · NPPES record last updated Nov 15, 2019
Key facts
- NPI
- 1902371073
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- ATLANTA SPORTS PODIATRY
- Practice address
- 9700 Medlock Bridge Rd Ste 126
Johns Creek, GA 30097-4408 - Phone
- (770) 614-0003
- NPI assigned
- Oct 4, 2018
- Organization subpart
- No
Authorized official
- Name
- Jay E Spector, DPM
- Title
- Owner
- Phone
- (770) 614-0003
Practitioners 1
-
Jay Erin Spector, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181207001266 | GA | Part B Supplier - Clinic/Group Practice | 4284978826 |
Receives reassigned benefits from 1 practitioner Practice locations: Duluth, GA |
National Provider Directory
Locations
9700 Medlock Bridge Rd
Ste 126
Johns Creek, GA 30097
Phone (404) 614-0003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
9700 Medlock Bridge Rd Ste 126
Johns Creek, GA 30097-4408
Mailing address
9700 Medlock Bridge Rd Ste 126
Duluth, GA 30097-4408
Phone (770) 614-0003
Other providers in Johns Creek, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.